For healthcare professionals only

Bmj Usa: Editor's Choice

State-sanctioned murder

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E179

From BMJ USA 2003;Jan:2

For ages, criminals were put to death by hanging, stoning, and beheading, but most modern nations abandoned such brutality years ago. Not all nations, however. Amnesty International reports that although 222 countries, including almost all Western nations, have eliminated the death penalty (or restrict it to exceptional circumstances), 84 countries continue to kill their citizens, among them the United States. The US ranks fifth in how many people it executes, placing it slightly behind Iran and ahead of Afghanistan.

Since 1976, when the US Supreme Court reinstated capital punishment, 820 executions have been performed in 32 states. Human rights groups across the globe implore us to stop, but to no avail. Our justification for killing our citizens is that they have killed others, often in horrific ways. Capital punishment is not murder, so the argument goes; the state kills criminals, whereas the criminals killed innocents. Whatever the justification, the hard truth is that electrocutions and lethal injections are acts of murder.

Arguments for and against the death penalty have raged for years. Proponents see it as just, the ultimate punishment for the ultimate crime. Some victims' survivors find solace in retribution. The death penalty is promoted as a safeguard, preventing future crimes by taking the assailants off the streets forever and by deterring future criminals.

Whether today's execution deters tomorrow's crime is uncertain but bears little on the moral depravity of the act. The executioner takes a human life—what is this but murder? As Jimmy Carter said, “War is sometimes a necessary evil, but it is always evil.” Murdering Germans to defeat Hitler was one such necessity, but it was murder nonetheless. The higher purposes that condoned the bloodshed at Normandy hardly apply to injecting pancuronium into Texas inmates. Executions make the world no better; they defile it. The executioner and murderer descend into moral purgatory through different stairwells, but both emerge from the killing chamber with blood on their hands and corpses haunting their memory. DNA evidence reveals how often this irreparable tragedy befalls the innocent.

Organized medicine warns physicians that they have no place in this sordid business (BMJ USA p 47). Yet physicians are involved, often by state mandate. Sometimes the involvement is indirect, as when a psychiatrist documents mental competency for execution. Sometimes a physician is in the execution chamber to certify death. But Groner shows us how lethal injection, the predominant form of capital punishment, has made physician involvement conspicuous (BMJ USA p 47). How physicians justify this is unclear. For some the answer is pecuniary; others see a societal duty. Bailey says it may be humanism: death is inevitable and physicians can offer comfort (BMJ USA p 50). Is it wrong to wonder whether Hitler's doctors clung to this rationalization? It is certainly wrong for those who agree with Groner to stay silent. “Indifference,” said George Bernard Shaw, “is the essence of inhumanity.”

Articles cited in Editor's choice are listed below, beginning with their BMJ USA page number:

BMJ USA p 47 Lethal injection: a stain on the face of medicine (Groner),

BMJ USA p 50 Commentary (Bailey),

View Abstract